When I was getting on SSRI's I had a bad reaction to Zoloft. It made me feel jazzed and made sleep onset difficult. Fortunately, citalopram works great for me. But that experience was enough to prove to me that these medications have different impacts on different people.
One could just as well ask psychiatrists who present an overly rosy picture this:
"If one person becomes reluctant to seek care because they hear stories from patients whose concerns were dismissed, who weren't properly informed of the risks before they tried the medication, who were then disbelieved by their doctor when they complained about serious side effects or withdrawal symptoms - HOW WOULD YOU FEEL?"
Because this totally happens.
These "rosy" psych docs live in a world of their own where psych patients never talk to each other. In a world where each psych patient has sane and neurotypical friends and acquaintances only. In a world where psych patients don't even have internet access. Therefore, you can paint a picture as rosy as you like and it will never be a problem, since YOU are your patient's only source of information. Like WTF. Maybe YOU should go to therapy and discuss how you came to develop these strange delusions.
My GP prescribed me amitriptyline for sleep. I asked him about the possible side effects. He told me just that it could make me sleepy, that was all. I looked it up afterward. It can cause glaucoma, which my mom got at an early age after using amitriptyline and a huge cocktail of other meds. It can also trigger mania, which I had *just* been trying to convey to the doctor that I was at risk for. This doesn't even have a huge impact on my judgment of that doctor because this kind of dismissal of side effects has been practically universal in my experience—the two psychiatric nurse practitioners at different practices who told me Adderall/Ritalin couldn't cause addiction, withdrawal, or tolerance; the PNP who dismissed my report of a hypomanic (maybe manic) episode when I started bupropion as impossible because bupropion doesn't cause mania like SSRIs do, who never replied when I emailed her a meta-analysis finding that it does; the very first person to prescribe me psych meds when I was 16, a psychiatrist in a cowboy hat who gave me three sampler packs of Lexapro and pressured me to stay on for at least 6 weeks despite it causing intensely distressing side effects, because Lexapro was new and safer than the other SSRIs, no mention of the black box warning that already existed for patients of my age group. After reading this substack, I now understand that it isn't psych meds that I'm hostile to, but the institutional conditions that make unethical, unsafe, and dishonest prescribing practices far more common than thoughtful and attentive care.
I had a psychiatrist tell me that you don't build up a tolerance against Propavan like you often do to other types of sleeping pills. When I told him I used to sleep hard on half a pill, but now I could take two and still be awake all night, so I seemed to have developed a tolerance after all, he just said "no".
I'm like ???? I'm telling you what happened!
Doc: "No."
TBF, this was the worst psychiatrist I've ever had. I've also learnt from other psychiatrists that yes, you can totally build up a tolerance against Propavan and this is well known. *sigh*
I wish I knew where people are finding psychiatrists who listen and read the research at all... I looked up ratings on local ones once and they were all shockingly bad.
Dr. Aftab, I wonder what you think of the claims of mind-body medicine / Pain Reprocessing Therapy practitioners like Howard Shubiner, who have gone from somewhat fringe toward mainstream through their Boulder back pain study (Ashar et a., 2022, JAMA Psych). In particular, I wonder if you think some of the discontinuation symptoms could be, in their terms, the brain continuing to maintain the symptoms (e.g., the sexual dysfunction side-effects) after the original causes pass or nocebo effects based on imagined "strain on the body" to quote the person micro-tapering from the "Surviving Antidepressants" forum (which may be a nocebo induction in itself). In the case of the persisting sexual dysfunction symptoms, this would be another kind of "physician disbelief," but one that would suggest something "real" going on besides persisting depression, and it would suggest a treatment (PRT or another CBT variant for somatic symptom disorders, perhaps combined with sexual dysfunction therapy elements). I guess your answer is in the op-ed--we need research on discontinuation to address these questions. That said, I would be interested in any thoughts you have on the Sarno/Shubiner/PRT/mind-body medicine movement, because they make strong claims about conditions/symptoms being psychogenic ("mind-body"; "neuroplastic"), and they are aggressively disseminating their perspective and treatment approach (documentary, book timed with publication of study, coaching certifications, etc.).
When I was getting on SSRI's I had a bad reaction to Zoloft. It made me feel jazzed and made sleep onset difficult. Fortunately, citalopram works great for me. But that experience was enough to prove to me that these medications have different impacts on different people.
One could just as well ask psychiatrists who present an overly rosy picture this:
"If one person becomes reluctant to seek care because they hear stories from patients whose concerns were dismissed, who weren't properly informed of the risks before they tried the medication, who were then disbelieved by their doctor when they complained about serious side effects or withdrawal symptoms - HOW WOULD YOU FEEL?"
Because this totally happens.
These "rosy" psych docs live in a world of their own where psych patients never talk to each other. In a world where each psych patient has sane and neurotypical friends and acquaintances only. In a world where psych patients don't even have internet access. Therefore, you can paint a picture as rosy as you like and it will never be a problem, since YOU are your patient's only source of information. Like WTF. Maybe YOU should go to therapy and discuss how you came to develop these strange delusions.
My GP prescribed me amitriptyline for sleep. I asked him about the possible side effects. He told me just that it could make me sleepy, that was all. I looked it up afterward. It can cause glaucoma, which my mom got at an early age after using amitriptyline and a huge cocktail of other meds. It can also trigger mania, which I had *just* been trying to convey to the doctor that I was at risk for. This doesn't even have a huge impact on my judgment of that doctor because this kind of dismissal of side effects has been practically universal in my experience—the two psychiatric nurse practitioners at different practices who told me Adderall/Ritalin couldn't cause addiction, withdrawal, or tolerance; the PNP who dismissed my report of a hypomanic (maybe manic) episode when I started bupropion as impossible because bupropion doesn't cause mania like SSRIs do, who never replied when I emailed her a meta-analysis finding that it does; the very first person to prescribe me psych meds when I was 16, a psychiatrist in a cowboy hat who gave me three sampler packs of Lexapro and pressured me to stay on for at least 6 weeks despite it causing intensely distressing side effects, because Lexapro was new and safer than the other SSRIs, no mention of the black box warning that already existed for patients of my age group. After reading this substack, I now understand that it isn't psych meds that I'm hostile to, but the institutional conditions that make unethical, unsafe, and dishonest prescribing practices far more common than thoughtful and attentive care.
Damn, that's a lot.
I had a psychiatrist tell me that you don't build up a tolerance against Propavan like you often do to other types of sleeping pills. When I told him I used to sleep hard on half a pill, but now I could take two and still be awake all night, so I seemed to have developed a tolerance after all, he just said "no".
I'm like ???? I'm telling you what happened!
Doc: "No."
TBF, this was the worst psychiatrist I've ever had. I've also learnt from other psychiatrists that yes, you can totally build up a tolerance against Propavan and this is well known. *sigh*
I wish I knew where people are finding psychiatrists who listen and read the research at all... I looked up ratings on local ones once and they were all shockingly bad.
IDK either. I've had lots of psychiatrists over the years. One really bad, one really good, several middling. But it was all random.
Dr. Aftab, I wonder what you think of the claims of mind-body medicine / Pain Reprocessing Therapy practitioners like Howard Shubiner, who have gone from somewhat fringe toward mainstream through their Boulder back pain study (Ashar et a., 2022, JAMA Psych). In particular, I wonder if you think some of the discontinuation symptoms could be, in their terms, the brain continuing to maintain the symptoms (e.g., the sexual dysfunction side-effects) after the original causes pass or nocebo effects based on imagined "strain on the body" to quote the person micro-tapering from the "Surviving Antidepressants" forum (which may be a nocebo induction in itself). In the case of the persisting sexual dysfunction symptoms, this would be another kind of "physician disbelief," but one that would suggest something "real" going on besides persisting depression, and it would suggest a treatment (PRT or another CBT variant for somatic symptom disorders, perhaps combined with sexual dysfunction therapy elements). I guess your answer is in the op-ed--we need research on discontinuation to address these questions. That said, I would be interested in any thoughts you have on the Sarno/Shubiner/PRT/mind-body medicine movement, because they make strong claims about conditions/symptoms being psychogenic ("mind-body"; "neuroplastic"), and they are aggressively disseminating their perspective and treatment approach (documentary, book timed with publication of study, coaching certifications, etc.).